Effect of omega-3 fatty acid on contrast-induced nephropathy

Renal failure that develops acutely after the use of iodinated contrast material is called "contrast-induced nephropathy". It is a complication with high morbidity and mortality risk. Current treatments are aimed at protecting kidney functions, new treatment methods are being researched. This study aims to demonstrate the therapeutic effects of omega-3 fatty acids on CIN, taking into account the possible clinical usage of iodinated contrast media and the benefits of omega-3 fatty acids. Methods. A total of 30 rats were studied, divided into four groups. Only saline was administered by gavage to group 1, only IV urography to group 2, only 400 mg omega-3 to group 3, and urography and 400 mg omega-3 to group 4. At the end of the study, kidney tissue and serum oxidative and antioxidant markers, and creatinine levels were analyzed. Result. While the degrees of glutathione peroxidase, catalase and total antioxidant capacity in kidney tissue and serum tests of rats treated with omega-3 fatty acid increased statistically; total oxidant capacity and malondialdehyde levels were found to be significantly lower. Furthermore, blood urea nitrogen and creatinine levels were found to be significantly lower in the omega-3 treated group. Conclusion. Omega-3 fatty acids had therapeutic effects in the experimental CIN model. As a result, we believe omega-3 fatty acids can be used as an alternative to existing supportive medicines in this common disease with few therapy options.

PP162 Use Of The RenalGuard® System To Prevent Contrast-Induced Nephropathy

IntroductionContrast-induced nephropathy (CIN) is a common cause of hospital-acquired acute kidney injury (AKI) following the administration of contrast media for coronary interventions or procedures such as diagnostic coronary angiography. The optimal way of preventing CIN remains uncertain. However, preliminary intravenous hydration, minimizing the volume of contrast media, and avoiding the use of nephrotoxic drugs are recommended in current management guidelines. The aim of this analysis was to compare the RenalGuard® system with standard care.MethodsA comprehensive literature search was conducted in PubMed and Google Scholar to identify evidence on the clinical and economic effectiveness of forced diuresis with matched hydration using the RenalGuard system for preventing CIN. Multiple criteria decision analysis (MCDA) was used to assess the performance of the method in hospital settings, compared with alternative options.ResultsSeveral systematic reviews with meta-analyses demonstrated that forced diuresis with matched hydration using the RenalGuard system was associated with a significantly lower relative risk of CIN among high-risk patients with chronic kidney disease. However, the evidence supporting the advantage of the proposed method over current forced diuresis techniques with manual calculation of the volumes for matched hydration in the hospital setting was limited.ConclusionsAlthough the effectiveness of the RenalGuard system has been demonstrated in meta-analyses, its clinical advantage over forced diuresis with manual hydration calculation is uncertain. It is also worth noting the lack of evidence to date on this technology, the fact that it is still at the research stage in some countries, and that it is not included in CIN management guidelines.

651 Prevention of contrast induced nephropathy with urine alkalinization: the final results of the TEATE study

Aims Contrast-induced acute kidney injury (CI-AKI) after coronary angiography and percutaneous interventions (PCI) impacts on hospitalization duration and mortality. Pre-procedural hydration is the sole strategy currently recommended for preventing CI-AKI. The role of sodium bicarbonate (SB) although attractive, since urine alkalinization suppresses the production of reactive oxygen species, is still controversial, and the optimal dosing to attain adequate urine alkalinization is still undefined. The PrevenTion of contrast-inducEd nephropathy with urine alkalinization (TEATE) study was a prospective 3-centre 3-arm single-blind randomized controlled trial testing the hypothesis that adequate urine alkalinization is associated with CI-AKI prevention. Secondary endpoints were the efficacy of SB vs. saline in achieving adequate urine alkalinization and reducing the incidence of CI-AKI compared with saline. Methods and results Patients candidate to coronary angiography and/or PCI with moderate-to-severe chronic kidney disease [eGFR of 15–60 ml/min/1.73 m2, by the Modification of Diet in Renal Disease Study equation (MDRD)] were randomly assigned to saline hydration (control), oral SB or i.v. SB. The study protocol was registered (ClinicalTrials.gov NCT02980003). We evaluated urinary pH at the time of hospitalization, immediately before coronary angiography and 24–48 h after angiography. According to urine pH immediately before the procedure, patients were divided in two groups above or below a pH cut-off of 6. We enrolled a total of 241 patients: 81 were randomly assigned to the control group, 82 to i.v. SB and 78 to oral SB. Patients achieving a urinary pH > 6 before angiography had a lower incidence of CI-AKI (46%) than patients with urinary pH ≤ 6 (54%) [OR = 0.48 (95% CI: 0.25–0.9), P = 0.023]. The number of patients with urine pH > 6 was higher in both the i.v. (71%) and the oral SB (65%) groups compared to the hydration-only group (44%, P = 0.004). We found however no difference in the incidence of CI-AKI in the three treatment arms (20% in hydration alone, 21% in oral SB group and 22% in i.v. SB group) (P = 0.94). Subgroup analyses according to basal urine pH and eGFR ranges failed to identify statistically significant differences in the development of CI-AKI according to treatment allocation. Conclusions Urinary pH before the administration of contrast medium is an inverse correlate of CI-AKI incidence, and SB is superior to hydration alone in achieving urinary alkalinization. Since, however, SB did not reduce the incidence of CI-AKI, we conclude that urinary pH is a marker and not a mediator of CI-AKI.

PP146 Use Of Carbon Dioxide In Endovascular Surgery To Prevent Contrast-Induced Nephropathy

IntroductionInterventional procedures often use iodinated contrast media (ICM) to visualize the area of interest. However, the use of ICM can cause contrast-induced nephropathy (CIN), which is a frequent complication after catheterization and is associated with morbidity and mortality. CIN is also a common complication in patients with pre-existing chronic kidney disease, diabetes, and heart failure. The purpose of this analysis was to compare carbon dioxide (CO2) with conventional contrast agents.MethodsTo assess the clinical effectiveness of CO2 in preventing CIN, a systematic review of relevant literature, including international guidelines, from the Medline database was conducted. Imaging of the chest, aorta, coronary arteries, and cerebral circulation with CO2 is limited, so effectiveness was determined in the field of renal and peripheral artery angioplasty. The effect on intervention cost was the main outcome.ResultsUse of CO2 generally reduced renal toxicity and anaphylactic reaction, but the benefits remain controversial. Angiography with CO2 is reasonable when image accuracy is not crucial due to its low informative value. Strategies for preventing acute kidney injury demonstrated the effectiveness of sodium chloride administration before and after the procedure. Additionally, the absence of risk factors for kidney disease significantly reduced the risk of impaired renal function.ConclusionsAlthough CO2 is one of the alternative methods for visualization, it is not pivotal in preventing CIN, even though the manufacturers recommend CO2 as the preferred contrast agent in patients with renal insufficiency who are allergic to ICM. The economic indicators for the use of CO2 are similar to traditional visualization methods.

Contrast Induced Nephropathy and its predictors after Primary Percutaneous Intervention

Background and Aims: Worldwide many patients are receiving intravascular contrast media (CM) during interventional procedures. Contrast media are used to enhance visualization and guide percutaneous coronary interventions (PCI).1 However, the use of CM also carries the risk of complications and it is important to be aware of these complications. Complications with CM range from mild symptoms to life-threatening conditions like anaphylaxis, hypotension and renal dysfunction and contrast-induced nephropathy (CIN) is one of them which can have both short and long term consequences.2 This study aimed to know the incidence of CIN in our center and possible predictors associated with it. Methods: This is the single hospital based cross sectional observational study. Patients undergoing primary PCI were enrolled in the study. All the patients underwent thorough history taking and physical examination. Baseline required laboratory investigations were sent. Electrocardiogram and echocardiography screening was done before taking patient to primary PCI as per the protocol of the hospital. Results: The number of patients enrolled in the study was 83 out of which 65(78.2%) were males and mean age was 59.7±13.2. Mean Arterial Pressure (MAP) among the patients was 103.8±21.3. Almost 2/3rd of the population received intravenous fluids. Minimum contrast volume used was 50ml and maximum was 270. When absolute rise in creatinine was considered 12 (14.5%) had CIN and when percent rise was also considered total 28 (33.7%) had CIN. While evaluating the predictors of CIN, higher mean age (p=0.01), hypotension with mean MAP <60 mmhg (p=0.04)) and higher contrast volume >100ml (p=0.04) was found to be significant. Conclusion: The incidence of CIN in patients undergoing PPCI was similar to the studies done in other parts of the world. Evaluating the predictors of CIN, higher mean age, hypotension and higher contrast volume was the significant predictor.